Laser treatment in twin-to-twin transfusion syndrome

Twin-to-twin transfusion syndrome (TTTS) is a severe fetal condition that has regained attention since surgical endoscopic treatment proved beneficial in a randomized controlled trial. Our objective is to review published series of cases treated with fetoscopic surgery. Diagnostic criteria, surgical technique, and perinatal outcome of series of TTTS cases treated by laser were reviewed. Over 1300 cases from 17 publications have been included, with a median perinatal survival rate of 57% (50-100%); brain lesions were present in 2-7% of the survivors at the age of 1-6 months. The percutaneous technique has gained wide acceptance, with an acceptable risk of maternal morbidity but a significant risk of miscarriage or preterm rupture of the membranes, presenting in 6.8-23% and 5-30%, respectively. The conclusion is that standardization of the technique and stability to improvement of the initial results should broaden the use of this technique. The overall survival rate at birth was 66% (1894/2869). However, variations in survival rates between centres and inconsistency in the reporting of complications call for more homogeneity in the pre- and post-operative assessment.